Clinical presentation of tuberculosis in adolescents as seen at National Hospital Abuja, Nigeria

Background: Adolescents with tuberculosis (TB) form a significant proportion of childhood TB cases presenting with specifics clinical patterns.Objective: To describe the clinical presentation of tuberculosis in adolescent at National Hospital Abuja (NHA), Nigeria.Subjects and method: This is a descriptive and retrospective study of adolescents aged 10- 15 years seen at the department of Paediatrics NHA Nigeria from August 2009 to July 2013.Result: Thirty- six adolescents diagnosed with tuberculosis were reviewed. Adolescent TB accounted for 18.8%(36/192) of total cases of children aged 0- 15years seen at the Department of Paediatrics Respiratory Clinic during the study period. The mean (SD) age was 12.3(1.76) years. Twenty seven patients (75.0%) were females and 9(25.0%) were males. Thirty (83.3%) were of lower socioeconomic class. History of contact with a case of TB was obtained in 17(47.2%). The commonest symptoms identified in these adolescents were; cough 27(75.0%), weight loss 22 (61.1%), fever18(50.0%), sputum 14(38.9%), body swelling 7(19.4%), hemoptysis 2(5.6%); while signs were underweight, pyrexia and chest findings. Nine (25.0%) had associated retroviral disease. Thirty four (94.4%) presented at time of diagnosis with clinical symptoms while 2(5.6%) were asymptomatic; identified during contact tracing as latent TB infection (LTBI). Abnormal chest radiograph findings were; widespread lung infiltrate in 10(27.8%), hilar opacities 7(19.4%), cavitatory lesions 4(11.1%), pleural Effusion 3(8.3%) and military opacities 1(2.7%). AFB was isolated in 5(13.9%), while 23(63.9%) had a raised ESR above 30mm/hr. Twenty seven (75.0%) of the adolescents completed treatment for tuberculosis, 7(19.4%) were lost to follow up and 2(5.6%) died while 4(11.1%) had re- treatment for TB from relapse. Clinical presentations were pulmonary TB (PTB) 22(61.1%), and extrapulmonary TB 12(33.3%); distributed as TB adenitis 4(11.1%), TBM 3(8.3%), Pericardial TB 3(8.3%), Miliary TB 1(2.8%) and Spinal TB 1(2.8). Of the nine with HIV- TB coinfection, the clinical presentation were; PTB 5(55.6%), and extrapulmonary 4(44.4%).Conclusion: The patterns of TB in adolescents are admixture as seen in younger children and adult from clinical and radiological characteristic findings. TB remains a preventable disease condition and is curable with early appropriate treatmentKey words: Adolescent tuberculosis, clinical patter

Pattern of liver diseases among children attending the National Hospital Abuja, Nigeria

Background: Diseases of the liver contribute to childhood morbidities and mortality. Early recognition and proper management of liver diseases can limit the progression to irreparable damage which requires liver transplant. However, there is scarcity of data in the pattern of liver disease in Nigerian children.Objective: To describe the pattern of paediatric liver diseases among children seen at the National Hospital, Abuja.Methods: A retrospective, descriptive study conducted at the Paediatric Gastroenterology, Hepatology and Nutrition (PGHAN) clinic and the Emergency Paediatric Unit (EPU) of National Hospital Abuja, over a 5- year period (2009 – 2014). The diagnosis of liver diseases was made from clinical and laboratory features. The data extracted from the retrieved hospital records were analyzed.Results: Forty-two out of 52 documented cases were analyzed. The children were aged 2 months to 15 years with the mean of 7.24 ± 4.77 years. Twenty-six (62.0%) were aged >5 years (p>0.05). They comprised 31 (73.8%) males and11 (26.2%) females; 28 (66.7%) belonged to the lower socioeconomic classes while 23 (54.8%) had various forms malnutrition. Common symptoms included jaundice (30; 71.4%), abdominal pain (17; 40.5%), fever (15; 35.7%), abdominal swelling (12; 28.6%) and bleeding (8; 19.0%). The signs included jaundice (30; 71.4%), hepatomegaly (16; 38.1%) and splenomegaly (8; 19.0%). Twenty-four (57.1%) had chronic viral infections while the others included neonatal hepatitis syndrome and biliary atresia (6; 14.3%), acute hepatitis (6; 14.3%) and chronic hepatitis of unidentified aetiology (4; 9.5%). Overall, the mean values of the liver enzymes and serum bilirubin were elevated while the mean values of total serum proteins and albumin levels were reduced. Five (11.9%) children improved and were discharged, 15 (35.7%) were lost to follow up with three deaths.Conclusion: Risk factors associated with liver diseases in this study included age over 5 years and lower socio-economic classes. Jaundice was the commonest clinical presentation while the most common aetiology was chronic Hepatitis B virus infection.Keywords: Children, Liver Diseases, Patter

Case Report: Recurrent Respiratory Papillomatosis: A Report of two cases and review of literature

Background: Recurrent Respiratory Papillomatosis (RRP) is a non-cancerous tumour of the upper airway caused by the human papilloma virus, presenting as “wart-like” growth, which could be anywhere from the nose to the lungs commonly in the larynx.Design and Setting: Review of two cases at the National Hospital Abuja (NHA).Objectives: To highlight the challenges in the management of RRP.Subjects: Two patients diagnosed with RRP were referred to the paediatric respiratory clinic between 2009 and 2012. Case one is a four year old female who presented with persistent hoarseness of voice, breathing difficulty and noisy breathing of one year duration. She was born at term by spontaneous vertex delivery to a mother who had vaginal warty lesion excised during pregnancy. A neck X-ray showed opacities around the laryngeal region with total obliteration of air column with histological confirmation of squamous papilloma. She had eight excision surgeries within a two years period with treatment with oral acyclovir, interferon, and methotrexate and tracheotomy tube in situ. Case two, a six year old female presented with persistent hoarseness of voice that progressed to loss of voice, noisy and difficulty in breathing, snoring and frequent arousal from sleep of 1½ years. Histology was diagnostic of laryngeal Papillomatosis and she had two excisions surgeries and treatment with oral acyclovir and tracheotomy tube in place.Conclusion: RRP though a slow growing tumour, presently has no definitive cure. Excision surgeries provide temporal relief and antiviral agents adjuvant therapies. Prevention with vaccination is desirable.Keyword: Recurrent respiratory Papillomatosis, Human papilloma virus

Fermoral Intercondylar Notch Geometry Of Nigerians

Ninety-four cadaveric femoral bones consisting of 60males and 34 females type were collected and treated for preservation through standard procedures. Using the caliper method, the intercondylar notch width, Notch depth and diameter of distal end of femur were measured. The notch shape index and notch width index were also calculated. The mean notch depth was found to be 3.30 + 0.14 for the 94 femur bones. It was found to be 3.23 + 0.14 for male 3.37 + 0.20 for females. The sex differences in notch depth were statistically insignificant (P>0.05). The diameter of the distal end of femur was 7.98 +0.60 for male bones and 7.85 + 0.55 for female bones and the difference between male and female proved statistically significant (P0.05). The notch shape index (NSI) was calculated by dividing the notch width with notch depth. The Notch width index (NWI) was calculated by dividing the notch width with the diameter of the distal end of femur and the difference in value between male and female (NWI) proved statistically significant (

Assessment of quality of life among children with bronchial asthma and their caregivers at the National Hospital Abuja, Nigeria

Background: The global disease burden associated with bronchial asthma has continued to increase particularly among children. Asthma-related quality of life is a health related assessment of disease impact on patient and care givers.Aim: To determine the perceived quality of life (QOL) among children with bronchial asthma and their caregivers as well as the related factors.Subjects and methods: This was a prospective study of children diagnosed with bronchial asthma and the caregivers attending the Respiratory Clinic of the National hospital Abuja, Nigeria. Using the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Paediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ) information from the various domains was obtained. The PAQLQ 23 questions assessed the child physical domain (5), emotional (8) and social behaviors (10), and the PACQLQ 13 questions assessed the caregivers’ activity limitation domain (4) and emotional function (9).Mean QOL scores from each domain and overall scores were calculated based on a seven-point scale. A QOL score of 7 was reported as best with no impairment; score one as least and severest impairment; score 4 as mid point in the range from 2-6 of moderate degree impairment. Other information on the demographic biodata and clinical information from child and caregivers was also obtained.Results: Forty-three children and 43 caregivers each were enrolled, from August to December 2014. Patients were aged 7-15years; 25(58.1%) males, 18(41.9%) females; while caregiver’s were males 23(53.5%), females 20(46.5%), age range 21- 48years. 25(58.1%) caregivers were of middle- lower socio-economic status; 20(46.5%) children had persistent asthma, 22(51.2%) well controlled, 21(48.8%) partly controlled. Medication use were; none, 17 (39.5%); long acting beta2 agonist/ inhaled corticosteroids (LABA/ ICS), 13(30.2%); antihistamine, 8 (18.6%); leukotriene receptor antagonist (LTRA),5(11.6%). Overall mean QOL was 4.89(4.54- 5.24;95% CI) for the children and 4.6 (3.91- 4.82; 95% CI) for caregivers; correlation (R) 0.438 p=0.003. Multiple regression showed that females gender had significant impairment in mean QOL scores in the activity domain (p= 0.022), and those with poor control and severe asthma also had significant impairment in mean QOL (p <0.05).Conclusion: Asthma impacted QOL of both the asthmatic children and caregivers with female gender in the activity domain, severe and not well controlled disease as independent predictors of quality of life.Keywords: Asthma, Paediatrics, Caregivers, QOL, Assessmen